Early diagnosis of HIV infection is essential to decrease mortality, morbidity and transmission rates, allow counselling and assess suitability for treatment. The Community-based voluntary counselling and testing (CBVCT) services are commonly recognized as a good model to improve access to most-at-risk populations by promoting its early HIV diagnosis. These centres are in excellent position to improve all aspects of the HIV testing and counselling-including access, offer, uptake and effectiveness- for those vulnerable and hard to reach. The general objective of the project is to promote early diagnosis of HIV infection in Europe by improving the implementation and evaluation of community-based testing practices. This objective has been highlighted as well in the European public health agenda. The European Commission has included access to HIV testing as a priority in their “Community Action in the Field of Public Health Work Plan 2009”.Several proposals and actions related to HIV testing have been conducted or are currently being conducted in Europe: The expert meeting held in Stockholm on January 2008, organised by ECDC and ICRH, Ghent University, produced the report: “HIV testing in Europe: from policies to effectiveness", addressing the plan of action for the surveys on testing and counselling practices. Some of the European countries have universal access to health care, this means that anyone can access the health care system for free, unlike the United States, where the system is different and many people without resources can not access it. Nevertheless, most of the vulnerable groups, such as IDUs, MSM and migrants, because of lack of knowledge, risk perception, marginality, stigma or illegality, do not have active seeking behaviours for HIV testing or face important barriers to testing within the formal health care system. The proposed project will complement previous and current reports and actions, focusing on CBVCT practices, obtaining a deep understanding of these programmes and services across countries and standardizing protocols and indicators to improve their implementation and evaluation. The project will contribute to the creation of a network of CBVCT that will monitor and evaluate HIV testing activity, conduct operational research. Moreover, the project includes a research question to assess acceptability, feasibility and impact of introducing oral rapid test technologies at community-based VCT. To achieve this, first of all, we will assess the characteristics of the implementation of CBVCT programs in European countries by conducting a survey among national focal points in HIV. Secondly, we will agree on CBVCT specific good practice guidelines by qualitative study among users and providers. Thirdly, this information will allow us to propose a core group of indicators for monitoring and evaluation of CBVCT activity. Fourthly, a standardised protocol to monitor HIV testing activities from the established CBVCT network will be defined. This will also allow comparability of reported activity at international level. Finally, the assessment of the acceptability, feasibility and impact of introducing oral rapid testing technology at CBVCT network will be made through:1.Using a parallel testing algorithm during a period of 15 days, in which every person tested was tested in parallel with oral rapid test and the test used in that CBVCT service. 2. Description of users profile by administration of questionnaires to clients and providers and by description of pitfalls identified by users; 3.Study of variation of activity from the pre and post oral rapid test period: by introducing oral rapid test that will replace conventional tests and rapid blood test. The period of use of the rapid blood test will be compared with the previous period of conventional or rapid blood testing by analysing the number of tests performed and the prevalence of positive results. A referral system in each CBVCT service will be ensured, so the availability of ARV treatment for those diagnosed HIV positive will be warranted. Increasing number of CBVCT sites enrolled in the network and a major geographical coverage is expected in the future, increasing its contribution to the global surveillance of HIV testing. The results obtained in the project could be used by European stakeholders to improve the implementation of CBVCT, and strengthen capacity in the European countries, improving access to testing, early diagnosis and care for hard-to-reach groups
